This invention relates to medical instrumentation, and more particularly to a surgical instrument for suturing organs.
The invention can be used for resection of portions of organs with suturing of the remaining and removed parts of an organ, e.g. of a lung and other organs. However, the disclosed instrument can also be utilized to utmost effectiveness for conducting liver resections.
At present, liver resection surgery is performed purely manually, which takes a relatively long time (thus, in a single take there is resected a liver portion 5 to 8 mm long and 8 to 10 mm thick, with ligation of the vessels and ducts to both sides of the resection area), to say nothing of the operation more often than not being associated with considerable loss of blood and post-operational complications of various kinds.
There is known a surgical instrument for simultaneous resection of soft tissues and their suturing (cf. the U.S. Pat. No. 3,079,606, dated Mar. 5, 1963), usually employed for placing gastro-intestinal anastomoses. The instrument includes two pivotally connected parts, viz. a support part and a staple-receiving part, the two parts carrying at the working ends thereof opposed longitudinally extending jaws. The longitudinally extending jaw of the supporting part has made therein a longitudinal array of indentations for clinching the staples, i.e. for bending over the ends of the legs of the staples. The longitudinally extending jaw of the staple-receiving part carries staple magazines wherein, in opposition to the abovementioned indentations, there are made transverse slots for staples, accommodating therein staple drivers and staples. Each staple magazine has made therein longitudinal slots accommodating bars with wedge-shaped ends facing the staple drivers and adapted for cooperation with the staple drivers when the staples are driven out. The staple-receiving part has also made therein a longitudinal slot accommodating a knife blade for tissue-dissecting purposes, which is longitudinally movable jointly with the said bars. The staple-receiving and support parts in their operating position where they are brought together to define a suturing gap therebetween are retainable with a self-actuating locking device.
The hitherto known instrument is mainly intended for placing interintestinal juice anastomoses and operates, as follows. The longitudinal jaws of the instrument are inserted into the interior of the intestines which are to be sutured, through incisions made in the walls of the intestines, and the walls to be sutured are positioned between the longitudinal jaws which are in the spread position.
The two parts of the instrument are connected with the pivot, and the support and staple-receiving parts are relatively rotated to bring together their longitudinal jaws disposed on the working ends of these parts, until the suturing gap is defined therebetween, whereafter the two parts are locked with the locking device.
The bars with the knife blade are moved toward the longitudinal jaws, with the bars engaging by their wedge-shaped ends the staple-driving elements or drivers, whereby the drivers are moved along the slots in the staple-receiving part. Upon leaving the transverse slots, the staples pierce the tissue with their legs or prongs and engage the indentations or anvils in the jaw of the supporting part, whereby the staples are bent into a generally B-shape, firmly securing the tissue.
Simultaneously, the moving knife blade severs the tissue between the sutures. Following the suturing procedure, the supporting and staple-receiving parts are unlocked, and the instrument is removed from the suturing position. In this manner the intestinal walls have become sutured, and a clearance has been provided between the sutures to ensure the permeability of the intestine. The incisions in the intestinal walls, left after the withdrawal of the longitudinal jaws, are sutured by conventional suturing operation.
The structure of the suturing unit of the instrument provided for rapid placing of sutures on the remaining and removing portions of the organ, with simultaneous severing of the tissue between the rows of the staples, i.e. between the sutures. The instrument is operable for suturing and resection of liver portions as great as 15 to 20 mm.
However, the instrument would not provide for performing resection of a liver thicker than 20 mm, whereas the thickness of the human's liver varies, with the sectional dimension of its different portions being as great as 60 to 70 mm and even greater. Should a greater thickness than 20 mm be engaged by the instrument, it would result in the breakage of the capsule and of some of the vessels and ducts, bringing about intense blood loss.
Layer-wise or level-wise suturing, i.e. suturing of a greater thickness of the liver in several layers, with piercing the capsule by the longitudinal jaw of the supporting part and successively engaging each 15 to 20 mm thick layer, is impossible on account of the considerable cross-sectional size of the longitudinal jaw, the piercing and insertion of the longitudinal jaw resulting in substantial trauma and intense blood loss. On the other hand, a reduction of the cross-sectional dimensions of the longitudinal jaw of the supporting part of the hitherto known instrument cannot be attained, since this part takes up the load at stapling, and its reduction could bring about its considerable bending deformation yielding drastic impairment of the suture quality.
Furthermore, with the knife blade of the known instrument moving, there is sometimes observed the phenomenon of the resected tissue being dragged along by the blade throughout the entire length of the longitudinal jaws, which results in impaired quality of the severing and in trauma of the tissue adjoining the suture.
It can therefore be seen that the hitherto known instrument cannot effectively be used for performing resections of the liver in the layer-wise fashion when the liver is of a considerable thickness, i.e. in the majority of the portions of the liver.
It is an object of the present invention to provide a surgical instrument for suturing organs, which can perform layer-by-layer suturing and resection of a parenchymal organ of a considerable thickness, with minimized traumatism of this organ.